Is your kid sick enough to stay home?

Four-year-old Aedan, left, and his 2-year-old brother, Ethan, have had their share of ailments. Their mother, Amanda Casey, has had to take quite a few sick days from her job as a high school teacher to tend to such things as ear infections.

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Stay home or go to school?

(In all cases, if fever is present with change in behavior, keep the child at home)

Diarrhea: Go unless the stool is not contained in a diaper or causing accidents in toilet-trained children.

Vomiting: Go unless the child has vomited more than two times in 24 hours.

But the guidelines sometimes result in unnecessary visits to the doctor, unwarranted days off work/school and needless requests for antibiotics - especially when it comes to the "24-hour fever free" train of thought, said Dr. Peter Jung of Blue Fish Pediatrics in Houston.

Generally speaking, Jung said, a child with a fever is a child who is contagious. But the 24-hour fever-free rule is somewhat misguided, because most people still carry the virus that's making them ill even after the fever has passed.

And by the time a fever appears, other kids have already been exposed to the contagion.

"I understand a policy needs to be in place," Jung said. "But it's not a scientifically based policy. From a public health standpoint, quarantining the child is not going to make a difference."

Frequent hand and surface washing is a better way to contain contaminants, Jung said, at home and at school.

Parents can expect their children to come down with eight to 12 viral illnesses during the school year. Determining how sick is too sick to be at school is sometimes best defined not by the number on the thermometer, but by the child's activity level.

"If they can make it through a day of school without extra care or attention from a teacher or caregiver, they should go," Jung said.

Gwendolyn Johnson, manager of Houston ISD health and medical services, said sending a potentially sick child to school might very well result in a summons from the nurse's office, but nurses use their professional judgment before making that call.

What seems like a fever might be overheating during recess, Johnson said. An episode of vomiting might have nothing to do with a virus, but gulping too much air at lunchtime or nervousness about an exam. A headache might be related to being thirsty, in which case a few ounces of water will help.

But one thing parents cannot expect, she said, is school nurses to administer over-the-counter meds for tummy troubles, headaches or fever. HISD policy forbids medication that is not prescribed by a physician. That means kids with fever controlled by Tylenol or Motrin should stay home until they can make it through 24 hours without it.

Other common childhood maladies are rashes and pink eye. Johnson said unexplained rashes can be indicative of a contagious illness and should be checked out by a physician. Matted, draining eyes is another reason to keep a child home, Johnson said.

Casey relates to both sides of the story. She's a mother and a high school teacher.

"Some parents don't stop and think about how their child will interact during the school day if they're sick," Casey said. "They won't eat well, might sleep during class, not complete assignments … and teachers may not notice right away or even have time to stop and call you to tell you your child isn't well.

"You know your children best. Pay attention if they're acting differently. Work will survive without you for a day or two."